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  • Julio Alejandro Murra Saca, MD
    Gastroenterologist

  • Tel: (503) 2226-3131, 2225-3087, 2530-3334 al 37
    Edificio Centro Scan, Colonia Médica

  • San Salvador, El Salvador

EMOTIONAL ASPECTS

“Just thinking about that makes me
sick to my stomach!”
“When I relax and imagine a pleasant
scene, my headache goes away.”

One of the most important conditions in gastroenterology are digestive symptoms relations with the emotional aspects of the patient.

The gut-brain connection

Have you ever had a “gut-wrenching” experience? Do certain situations make you “feel nauseous”? Have you ever felt “butterflies” in your stomach? We use these expressions for a reason. The gastrointestinal tract is sensitive to emotion. Anger, anxiety, sadness, elation — all of these feelings (and others) can trigger symptoms in the gut.

The brain has a direct effect on the stomach. For example, the very thought of eating can release the stomach’s juices before food gets there. This connection goes both ways. A troubled intestine can send signals to the brain, just as a troubled brain can send signals to the gut. Therefore, a person’s stomach or intestinal distress can be the cause orthe product of anxiety, stress, or depression. That’s because the brain and the gastrointestinal (GI) system are intimately connected — so intimately that they should be viewed as one system.

This is especially true in cases where a person experiences gastrointestinal upset with no obvious physical cause. For such functional GI disorders, it is difficult to try to heal a distressed gut without considering the role of stress and emotion.



Irritable bowel syndrome is a fairly common condition becoming the most common cause of consultation with the gastroenterologist, irritable bowel syndrome which causes a wide range of abdominal symptoms such as: abdominal pain, gas, bloating, abdominal distension, constipation or diarrhea, or the combination and alternation of these symptomatology stools may be thin or round, he usually patient is quite anxious about serious illness that is happening internally as an obsession to cancer.


This condition has been referred to by various terms such as colitis, mucous colitis, spastic colon, the term colitis means inflammation of the large intestine (colon), irritable bowel syndrome does not cause inflammation and should not be confused with ulcerative colitis. These disorders have traditionally been classified as a functional disorder in their appearance because there is no underlying structural or biochemical abnormality.

What is the cause of this condition? The exact mechanism of this disease is not known but this condition is usually related to anxiety patients living in fear of some kind. Stress on lifestyle, work, home, etc. emotional conflicts. the concerns of each person is different but usually they are unnecessary concerns which can be addressed with alternating thoughts.

In irritable bowel syndrome should be excluded a number of diseases such as intestinal parasites, urinary tract infection, polyps, diverticula even colon cancer your doctor must rule out a lot of diseases before it be assumed that this condition , medical history with a good physical examination, clinical laboratory tests, abdominal ultrasonography and colonoscopy which will thoroughly examine the large intestine. Complete colonoscopy should be performed to exclude any person for any illness within the colon.


This video clip of a colonoscopy, must be completed from the rectum to the cecum. It must rule out colon disease, without this test the diagnosis of irritable bowel sujetivo only.

Dr. What diet is recommended:
It has been scientifically proven that diet with plenty of fiber help but many patients improve symptoms, as some patients also improve avoiding carbohydrates, but it must be emphasized that more than a diet the patient should look for a relaxed lifestyle an atmosphere of tranquility.



Dysphagia
Disorders leading to dysphagia may affect the oral, pharyngeal, or esophageal phases of swallowing. Thorough history taking and careful physical examination are important in the diagnosis and treatment of dysphagia. The bedside physical examination should include examination of the neck, mouth, oropharynx, and larynx. A neurologic examination also should be performed. Several clinical bedside swallowing assessments have been suggested, but videofluoroscopic swallowing studies, as shown in the image below, are accepted as the standard for detecting and evaluating swallowing abnormalities
Dysphagia is described as the feeling of difficulty in the movement of food from the mouth to the stomach. It can include difficulty initiating swallowing (dysphagia high) or a feeling that the transit of food has been arrested after being successfully swallowed (low dysphagia). This latter type of dysphagia can be associated with chest pain. While often dysphagia patients dread having cancer.

There are two types of dysphagia:
- Functional Dysphagia, this can be due to emotional
- Structural Dysphagia, the ocacionan tumors, polyps, etc. esophagitis.

All need to be evaluated dysphagia with upper gastrointestinal endoscopy.

Noncardiac chest pain. Noncardiac chest pain presents similar characteristics regarding their feeling and distribution of cardiac pain. It differs from the latter in that there are no signs of cardiac origin, and in most cases is due to a primary esophageal disorder.

Functional dyspepsia.
Functional dyspepsia (or non-ulcer) is a general, non-specific, used to describe a group of symptoms among which are swelling and bloating, belching and upper abdominal pain, and usually appear after meals . Before making a diagnosis of functional dyspepsia must exclude any detectable intestinal disorders.


CAN THE DIGESTIVE triggered by PSYCHO-SOCIAL FACTORS?.
It is known that more than 33% of the consultation in the specialty of gastroenterology and other specialties are associated with stress.

Its origin, according to experts, is related to:
- Difficulty to adapt to diets and defecation in childhood.
- Psychosocial Trauma unresolved (hospitalizations, surgeries, death of loved ones, etc.)
- Sexual or physical trauma.
- Cultural aspects or family.

The most frequent digestive consequences are:
- Irritable bowel syndrome
- Nonspecific stomach aches (dyspepsia).
- Initiates or decompensation of chronic nonspecific ulcerative colitis (UC)
- Erosive Gastritis - hemorrhagic.
- Ulcer of Duodenum and possible bleeding complication
- Skin diseases
- Vitiligo is an acquired pigmentary disorder of the skin and mucous membranes, and it is characterized
by circumscribed depigmented macules and patches. Vitiligo is a progressive disorder in which some or all of the melanocytes in the affected skin are selectively destroyed. Vitiligo affects 0.5-2% of the world population, and the average age of onset is 20 years.

- Psoriasis Psoriasis a complex, chronic, multifactorial, inflammatory disease that involves hyperproliferation of the keratinocytes in the epidermis, with an increase in the epidermal cell turnover rate. Environmental, genetic, and immunologic factors appear to play a role. The disease most commonly manifests on the skin of the elbows, knees, scalp, lumbosacral areas, intergluteal clefts, and glans penis. In up to 30% of patients, the joints are also affected.

Treatment includes a proper doctor-patient relationship, psychological support targeted to each particular situation and individualized drug therapy.

A relationship exists between the way
we manage emotions and pressures in
our lives and physical symptoms,
illnesses and diseases.
During the late 1800s and early
1900s, medical researchers proposed
that sad emotions adversely affected a
person’s body, that the repeated
expression of violent emotions could
influence heart disease, that prolonged
anxiety could promote hair loss, that
irregular menstrual cycles, skin
problems, sexual problems, fatigue and
urinary secretion were frequently
associated with difficult and painful
emotions.
Current research in this field, called
“psychosomatic” or “behavioral”
medicine, does not deviate sharply from
these early speculations.
About 20 years ago, a presidential
commission determined that many
Americans were dying from heart
attacks, cancer and accidents as a result
of their own behavior.
More recently, the Heart, Lung and
Blood Institute and the National Cancer
Institute were among health
organizations recognizing the
importance of psychology in both the
prevention and control of disease and
physical symptoms that can lead to
illness and disease.
There is a growing awareness that
our behavior, self-esteem, family life,
emotions and changes in lifestyle can
affect our dental hygiene, rehabilitation,
adaptation to handicaps, pain, etc.
Life situations involving conflict and
anxiety can actually cause physical
symptoms to appear or intensify preexisting medical conditions.
For example, arguments can bring on
headaches in an otherwise healthy
person or intensify the symptoms of
lupus or arthritis in those already
afflicted.


The Endoscopic Sonata no 8 Pathetique


The Untold History of The Gastrointestinal Endoscopy Part 2 (2/6)

Stress and the functional GI disorders

Given how closely the gut and brain interact, it becomes easier to understand why you might feel nauseated before giving a presentation, or feel intestinal pain during times of stress. That doesn’t mean, however, that functional gastrointestinal illnesses are imagined or “all in your head.” Psychology combines with physical factors to cause pain and other bowel symptoms. Psychosocial factors influence the actual physiology of the gut, as well as symptoms. In other words, stress (or depression or other psychological factors) can affect movement and contractions of the GI tract, cause inflammation, or make you more susceptible to infection.

In addition, research suggests that some people with functional GI disorders perceive pain more acutely than other people do because their brains do not properly regulate pain signals from the GI tract. Stress can make the existing pain seem even worse.

Based on these observations, you might expect that at least some patients with functional GI conditions might improve with therapy to reduce stress or treat anxiety or depression. And sure enough, a review of 13 studies showed that patients who tried psychologically based approaches had greater improvement in their digestive symptoms compared with patients who received conventional medical treatment.

Is stress causing your symptoms?

Are your stomach problems — such as heartburn, abdominal cramps, or loose stools — related to stress? Watch for these other common symptoms of stress and discuss them with your doctor. Together you can come up with strategies to help you deal with the stressors in your life, and also ease your digestive discomforts.

Physical symptoms

  • Stiff or tense muscles, especially in the neck and shoulders
  • Headaches
  • Sleep problems
  • Shakiness or tremors
  • Recent loss of interest in sex
  • Weight loss or gain
  • Restlessness


PSYCHOLOGIC AND PSYCHIATRIC ASPECTS OF GASTROINTESTINAL DISEASE

 

The history of gastroenterology is rich with observations that patients with chronic gastrointestinal symptoms, such as abdominal pain, constipation, diarrhea, and esophageal spasm, often display symptoms suggestive of concomitant emotional disturbance. The classic writings of Bockus et al and Alvarez, among others, are filled with such references. Alvarez, in writing about irritable bowel syndrome (IBS), described his IBS patients as being “tense, sensitive, nervous and having a worrisome temperament. They may be calm externally, but they usually seethe internally, and any strong emotion is likely to affect all those organs which are under the control of the autonomic nerves.” Bockus described IBS patients as “constipated, dyspeptic, depressed, introspective, exhausted, emotionally unstable or asthenic.” These observations are unacceptably vague and nonspecific when viewed from a contemporary perspective. The observations of these gastroenterologists also have been made obsolete by cultural changes that have occurred throughout the twentieth century. Because these disorders are seen more commonly in women, qualitative descriptions of these patients often have been influenced negatively by perceptions tainted by gender bias. The first step toward scientifically studying the functional gastrointestinal disorders was to create a common nomenclature for clinicians and for investigators.

For most of the twentieth century, the absence of standardized diagnostic criteria for functional gastrointestinal and psychiatric disorders hampered precise description and classification of these syndromes. In the last 15 years, however, significant advances have been made in diagnosis and classification of patients who suffer from functional gastrointestinal disorders. Beginning in 1988, international working teams that convened in Rome have formulated diagnostic criteria (Rome criteria) for the functional gastrointestinal disorders revolving around the various anatomic regions of the gut. The most recent update of these criteria was published in 2000. These diagnostic criteria for functional gastrointestinal disorders are not meant to be a conclusive document. Rather they are designed to provide a common basis for clinical description and research. In that sense, the Rome and Rome II criteria represent a living document that continues to be refined as knowledge improves. The diagnostic criteria for IBS, the most common functional gastrointestinal disorder.


The Endoscopic Symphony No 40 by MurraSaca


The Untold History of The Gastrointestinal Endoscopy Part 5 (5/6)